J.P.S. Bakshi Manual of Ear, Nose and Throat

Transcription

1 J.P.S. Bakshi Manual of Ear, Nose and Throat Reading excerpt Manual of Ear, Nose and Throat of J.P.S. Bakshi Publisher: B. Jain Copying excerpts is not permitted. Narayana Verlag GmbH Blumenplatz 2 D Kandern, Germany Tel Fax info@narayana-publishers.com In our online-bookshop we present all english homeopathy books.

2 4. Disorders of Internal Ear A. Labyrinthitis B. Meniere's disease C. Presbyacusis D. Otosclerosis E. Ototoxicity F. Neuritis of the Acoustic Nerve A. Labyrinthitis Introduction Labyrinthitis is the pyogenic inflammation of the labyrinth. Etiology 1. Following acute otitis media 2. Following operation on the stapes 3. Through preformed pathway like fracture lines 4. Removal of polypi or granulations arising from promontory 5. In chronic suppurative otitis media, cholesteatoma may cause erosion of semicircular canals usually of the lateral semicircular canal or the stapes, foot plate and promontory, thus exposing the labyrinth to the infective process. Types 1. Circumscribed (Paralabyrinthitis) 2. Diffuse 1. Circumscribed labyrinthitis The bony capsule is eroded and membranous labyrinth is exposed (fistula formation). Labyrinthitis is localized to the area of fistula only. 2. Diffuse labyrinthitis When inflammatory exudate is serofibrinous with only few round cells. This type is called diffuse serous labyrinthitis. If the inflammatory process continues the exudate becomes purulent, then the condition is known as diffuse purulent labyrinthitis.

3 64 Manual of Ear, Nose and Throat Clinical Features a. Clinical features of circumscribed labyrinthitisi. Attacks of dizziness ii. Nausea and vomiting iii. Ear discharge b. Clinical Features of diffuse labyrinthitis- The vestibular symptoms like dizziness, vertigo, vomiting and loss of balance are more important presenting symptoms. The patient lies on the sound ear and looks towards diseased ear. The hearing is not markedly affected in serous labyrinthitis. In purulent labyrinthitis, the vestibular symptoms are more severe in nature with intense giddiness, frequent vomiting and marked deafness. Spontaneous nystagmus is present towards healthy side. Patient lies in bed curled upon the side of his healthy ear. Vomiting may persist for few days. Management Pharmacological Treatment Labyrinthitis arising from an attack of acute otitis media is treated by an intensive course of antibiotics besides other general measures like bed rest and prescribing vestibular sedatives. Surgical Intervention Labyrinthectomy Homeopathic Repertorial References Direct references Ear; INFLAMMATION; inside; labyrinth On the basis of etiology acute otitis media Ear; INFLAMMATION; media, middle ear; acute operation on the stapes Generalities; INJURIES, blows, falls and bruises; operation, disorders from; orifices, on chronic suppurative otitis media Ear; INFLAMMATION; media, middle ear; chronic Ear; INFLAMMATION; suppurative

4 On the basis of clinical features Circumscribed labyrinthitis dizziness Vertigo; DIZZINESS Vertigo; GENERAL, vertigo in; dizziness Nausea and vomiting Stomach; NAUSEA Stomach; VOMITING; General; vertigo, during Ear discharge Ear; DISCHARGES Diffuse labyrinthitis dizziness Vertigo; DIZZINESS Vertigo; GENERAL, vertigo in; dizziness Nausea Stomach; NAUSEA vomiting Stomach; VOMITING; General; vertigo, during deafness Hearing; IMPAIRED nystagmus Disorders of Internal Ear 65 Eye; MOVEMENT; eyeballs; pendulum-like, from side to side B. Meniere's Disease Introduction This is a disease of inner ear characterized by the sudden and recurrent attacks of vertigo often associated with nausea and vomiting together with deafness and tinnitus. Clinical Features 1. Paroxysmal attacks of vertigo with deafness and tinnitus constitute the acute attacks of the deafness. In between acute attacks, there are remissions of varying duration. 2. Vertigo is the main complaint.

5 66 Manual of Ear, Nose and Throat 3. It is accompanied by nausea and vomiting. The attacks may last for a varying period of time and may recur at short intervals of time. 4. The remission or inactive phase - As the vertigo subsides the hearing loss and tinnitus may improve but with recurrent attacks, patient's hearing deteriorates and tinnitus becomes a constant feature. Variations of the clinical picture may occur owing to absence of one or more of the main features that constitute the disease. Investigations \. Audiometry - pure tone audiometry reveals the sensorineural deafness 2. Vestibular function test 3. Plain Radiography - plain radiography of the temporal bone helps to rule out internal acoustic meatus pathology 4. Glycerol test. Management Pharmacological Treatment 1. Prochlorperazine (stemetil) 2. Promethazine (Avomine, Phenargan) 3. Chlorpromazine (Largactil) 4. Dimenhydrinate (Dramamine) Surgical Intervention 1. Cervical sympathectomy 2. Myringotomy with grommet insertion 3. Operations on endolymphatic sac 4. Vestibular neurectomy 5. Labyrinth destruction, selective destruction of vestibular labyrinth by cryosurgery or ultrasound, can be done without any damage to cochlea and facial nerve. General Treatment The patient is put to bed rest. Any of vestibular suppressants is given to control the vestibular symptoms.

6 Homeopathic Repertorial References Direct references Vertigo; MENIERE 'S disease On the basis of presentation Disorders of Internal Ear 67 Vertigo; MENIERE'S disease; Raynaud's Disease, with Vertigo; MENIERE'S disease; raising head, sitting up agg. Vertigo; MENIERE'S disease; seasick, as if Vertigo; MENIERE'S disease; syphilitic Vertigo: MENIERE'S disease; women On the basis of clinical features vertigo Vertigo, PAROXYSMAL deafness Hearing; LOST Hearing; IMPAIRED; paroxysmal Hearing; IMPAIRED; vertigo, with Hearing; IMPAIRED; noises, with tinnitus Ear; NOISES in; General; vertigo; with nausea Stomach; NAUSEA; vertigo; after vomiting Stomach: VOMITING; General; vertigo, during Lermoyez's syndrome This is a variant of Meniere's syndrome in which hearing loss and tinnitus occur first, then the vertigo suddenly occurs, and with it hearing and tinnitus improve. Homeopathic Repertorial References On the basis of clinical features tinnitus ameliorated by vertigo Ear; NOISES in; General; vertigo; before

7 68 Manual of Ear, Nose and Throat C. Presbyacusis Introduction This is a type of sensorineural hearing loss which results due to ageing process and is an auditory manifestation of old age. Clinical Features 1. The patient of an elderly age group presents with a slow, progressive deafness which may be associated with tinnitus. 2. The deafness is bilateral and symmetrical, commonly affecting the high tones. Management General Treatment The patient should be given understanding of his problem and may sometimes be helped by a hearing aid. Homeopathic Repertorial References On the basis of clinical features progressive deafness Hearing; IMPAIRED; old people Hearing; IMPAIRED; noises, with D. Otosclerosis Introduction Otosclerosis is primarily a disease of bony labyrinth, which produces effects upon middle ear and inner ear functioning. Primary change is the formation of new spongy bone and chief secondary effect is ankylosis of foot plate of stapes. Precipitating Factors Pregnancy and puerperium may initiate or increase the deafness in Otosclerosis Types 1. Histopathological Otosclerosis 2. Clinical Otosclerosis a. Stapedial Otosclerosis

8 Disorders of Internal Ear 69 b. Cochlear otosclerosis c. Mixed 1. Histopathological Otosclerosis This type of otosclerosis does not produce any symptoms during life and is revealed only at post-mortem. 2. Clinical Otosclerosis a. Stapedial otosclerosis - otosclerotic focus may produce the ankylosis of stapes causing conductive deafness. b. Cochlear otosclerosis - when otosclerosis is encroached upon membranous labyrinth producing sensorineural deafness. c. Mixed - otosclerosis causes both fixation of stapes as well as involvement of labyrinth, so that there is mixed hearing loss. Clinical Features 1. Deafness is the common and outstanding symptom. 2. Paracusis willisi - A feature of deafness in majority of these cases is the presence of paracusis willisi, i.e. ability to hear speech better in a noisy surrounding, like in public transport, machine shops, engine rooms. 3. Tinnitus is usually complained by many patients. 4. Vertigo may be the occasional symptom Investigations 1. Otoscopy reveals the tympanic membrane as intact and mobile 2. Tuning fork tests reveal conductive deafness 3. Gelle's Test is negative 4. Pure tone audiometry Management Surgical Intervention 1. Bypassing the ankylosed stapes 2. Mobilization of the fixed stapes 3. Removal of the stapes

9 70 Manual of Ear, Nose and Throat Homeopathic Repertorial References Direct references Ear: OTOSCLEROS1S On the basis of precipitating factors pregnancy and puerperium Hearing: IMPAIRED: pregnancy, during Hearing: IMPAIRED; delivery; from On the basis of clinical features deafness Hearing; IMPAIRED; bone conduction deficient or absent; blockage; middle ear; otosclerosis, from Hearing; IMPAIRED; bone conduction deficient or absent; blockage; middle ear; otbsclerosis, from; carriage riding, amel. Hearing; IMPAIRED; bone conduction deficient or absent; blockage; middle ear; otosclerosis, from; noise, amel Hearing; LOST; otosclerosis, from paracusis willisi Hearing; IMPAIRED; noise amel. tinnitus Ear; NOISES in; General vertigo Vertigo; GENERAL, vertigo in E. Ototoxicity Introduction Ototoxicity may be defined as the tendency of certain therapeutic agents and other chemical substances to cause functional impairment and cellular degeneration of the tissues of the inner ear and especially of the end organs and numerous cochlear and vestibular divisions of the eighth cranial nerve. Etiology 1. Quinine and Salicylates 2. Diuretics 3. Antiheparinizing agents

10 J.P.S. Bakshi Manual of Ear, Nose and Throat 200 pages, publication 2002 More homeopathy books on